Scapular Region Hematoma in a Chronic Myeloid Leukaemia (CML) Patient: A Rare Case Presentation

Chronic myeloid leukaemia (CML) is a liquid tumour that occurs due to reciprocal translocation between chromosome 9 and 22 (Philadelphia chromosome) leading to the birth of a fusion gene bcr-ABL that up- regulates tyrosine kinase activity and inhibits apoptosis. A 26 years male presented with complaints of sudden onset non traumatic spontaneous swelling over the left scapular region and progressively extending up-to the left anterior chest wall which was associated with dull aching moderate intensity pain. Swelling was warm, soft in consistency and tender. He also had hepato-splenomegaly. Myeloid hyperplasia and a noticeable leucocytosis were seen in the overall blood picture. The diagnosis of spontaneous hematoma with CML was confirmed by diagnostic aspiration after a CT scan of the thorax revealed a large hypodense lesion in the scapular and anterior chest wall region. The existing hematoma did not increase in size and no new bleeding complication happened after imatinib commencement. Surgical approach in such cases is selected only in presence of complications like expanding hematoma, superimposed infection, abscess or mass effect at vital locations.

The hematoma was treated conservatively with antibiotics while imatinib therapy was initiated. Without the need for surgery, the swelling went away on its own.